Skip to main content

Advertisement

Log in

The identification of risk factors for increased postoperative pain following minimally invasive transforaminal lumbar interbody fusion

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To evaluate specific demographic and perioperative variables associated with higher inpatient pain scores following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Methods

Patients who underwent a single-level, primary MIS TLIF were retrospectively reviewed. Perioperative outcomes were collected, and postoperative inpatient VAS pain scores were measured. Both bivariate and stepwise multivariate Poisson regressions with robust error variance were used to assess risk factors for average inpatient pain score ≥ 5.0. A final backward stepwise regression model was created using age, gender, smoking status, diabetes status, insurance status, BMI, comorbidity burden, pedicle screw laterality, operative time, and estimated blood loss.

Results

A total of 255 patients undergoing primary, single-level MIS TLIF were included. Age less than 50 years, workers’ compensation insurance, preoperative VAS pain score ≥ 7, and operative duration ≥ 110 min were associated with greater postoperative pain. However, other variables such as gender, BMI, smoking status, comorbidity burden, diabetes status, and pedicle screw laterality were not associated with increased postoperative pain.

Conclusion

The results of this study suggest that younger age, workers’ compensation, elevated preoperative pain scores, and longer operative times are independently associated with greater inpatient pain following TLIF. Surgeons can use this information to better assess which patients may require additional pain control following TLIF. Patient expectations of postoperative outcomes in regard to pain and recovery may also be better managed.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material. (paragraph). Then process the ppt slide as graphical image.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lee MJ, Mok J, Patel P (2018) Transforaminal lumbar interbody fusion: traditional open versus minimally invasive techniques. J Am Acad Orthop Surg 26:124–131. https://doi.org/10.5435/JAAOS-D-15-00756

    Article  PubMed  Google Scholar 

  2. Garimella V, Cellini C (2013) Postoperative pain control. Clin Colon Rectal Surg 26:191–196. https://doi.org/10.1055/s-0033-1351138

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sommer M, de Rijke JM, van Kleef M et al (2008) The prevalence of postoperative pain in a sample of 1490 surgical inpatients. Eur J Anaesthesiol 25:267–274. https://doi.org/10.1017/S0265021507003031

    Article  CAS  PubMed  Google Scholar 

  4. Dorow M, Löbner M, Stein J et al (2017) Risk factors for postoperative pain intensity in patients undergoing lumbar disc surgery: a systematic review. PLoS ONE 12:e0170303. https://doi.org/10.1371/journal.pone.0170303

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kim H-J, Park J-H, Kim J-W et al (2014) Prediction of postoperative pain intensity after lumbar spinal surgery using pain sensitivity and preoperative back pain severity. Pain Med 15:2037–2045. https://doi.org/10.1111/pme.12578

    Article  PubMed  Google Scholar 

  6. Rutström E, Söndergaard S, Lundborg C, Ene K (2019) Postoperative pain experience, pain treatment and recovery after lumbar fusion and fixation surgery. Int J Orthop Trauma Nurs. https://doi.org/10.1016/j.ijotn.2019.01.004

    Article  PubMed  Google Scholar 

  7. Bohl DD, Louie PK, Shah N et al (2016) Multimodal versus patient-controlled analgesia after an anterior cervical decompression and fusion. Spine 41:994–998. https://doi.org/10.1097/BRS.0000000000001380

    Article  PubMed  Google Scholar 

  8. Bhatia A, Buvanendran A (2019) Anesthesia and postoperative pain control-multimodal anesthesia protocol. J Spine Surg 5:S160–S165. https://doi.org/10.21037/jss.2019.09.33

    Article  PubMed  PubMed Central  Google Scholar 

  9. van Tulder M, On behalf of the COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care, Becker A et al (2006) Chapter 3 European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 15:s169–s191

    Article  Google Scholar 

  10. Tiippana EM, Hamunen K, Kontinen VK, Kalso E (2007) Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. Anesth Analg 104:1545–1556. https://doi.org/10.1213/01.ane.0000261517.27532.80(table of contents)

    Article  CAS  PubMed  Google Scholar 

  11. Young A, Buvanendran A (2012) Recent advances in multimodal analgesia. Anesthesiol Clin 30:91–100. https://doi.org/10.1016/j.anclin.2011.12.002

    Article  PubMed  Google Scholar 

  12. De Oliveira GS, Almeida MD, Benzon HT, McCarthy RJ (2011) Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 115:575–588. https://doi.org/10.1097/ALN.0b013e31822a24c2

    Article  CAS  PubMed  Google Scholar 

  13. Farag E, Ghobrial M, Sessler DI et al (2013) Effect of perioperative intravenous lidocaine administration on pain, opioid consumption, and quality of life after complex spine surgery. Anesthesiology 119:932–940. https://doi.org/10.1097/ALN.0b013e318297d4a5

    Article  CAS  PubMed  Google Scholar 

  14. Hansen RN, Pham AT, Böing EA et al (2017) Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen. Curr Med Res Opin 33:943–948

    Article  Google Scholar 

  15. Gu J, Guan F, Zhu L et al (2016) Risk factors of postoperative low back pain for lumbar spine disease. World Neurosurg 94:248–254. https://doi.org/10.1016/j.wneu.2016.07.010

    Article  PubMed  Google Scholar 

  16. Macrae WA (2008) Chronic post-surgical pain: 10 years on. Br J Anaesth 101:77–86. https://doi.org/10.1093/bja/aen099

    Article  CAS  PubMed  Google Scholar 

  17. Chung F, Ritchie E, Su J (1997) Postoperative pain in ambulatory surgery. Anesth Analg 85:808–816. https://doi.org/10.1097/00000539-199710000-00017

    Article  CAS  PubMed  Google Scholar 

  18. DeBerard MS, LaCaille RA, Spielmans G et al (2009) Outcomes and presurgery correlates of lumbar discectomy in Utah Workers’ Compensation patients. Spine J 9:193–203. https://doi.org/10.1016/j.spinee.2008.02.001

    Article  PubMed  Google Scholar 

  19. Kehlet H, Jensen TS, Woolf CJ (2006) Persistent postsurgical pain: risk factors and prevention. Lancet 367:1618–1625. https://doi.org/10.1016/S0140-6736(06)68700-X

    Article  PubMed  Google Scholar 

  20. Hegarty D, Shorten G (2012) Multivariate prognostic modeling of persistent pain following lumbar discectomy. Pain Phys 15:421–434

    Google Scholar 

  21. Kanaan SF, Arnold PM, Burton DC et al (2015) Investigating and predicting early lumbar spine surgery outcomes. J Allied Health 44:83–90

    PubMed  PubMed Central  Google Scholar 

  22. Skolasky RL, Wegener ST, Maggard AM, Riley LH 3rd (2014) The impact of reduction of pain after lumbar spine surgery: the relationship between changes in pain and physical function and disability. Spine 39:1426–1432. https://doi.org/10.1097/BRS.0000000000000428

    Article  PubMed  Google Scholar 

  23. Li X, Veltre DR, Cusano A et al (2017) Insurance status affects postoperative morbidity and complication rate after shoulder arthroplasty. J Shoulder Elbow Surg 26:1423–1431. https://doi.org/10.1016/j.jse.2016.12.071

    Article  PubMed  Google Scholar 

  24. Veltre DR, Sing DC, Yi PH et al (2019) Insurance status affects complication rates after total hip arthroplasty. J Am Acad Orthop Surg 27:e606–e611. https://doi.org/10.5435/JAAOS-D-17-00635

    Article  PubMed  Google Scholar 

  25. Kim BD, Hsu WK, De Oliveira GS Jr et al (2014) Operative duration as an independent risk factor for postoperative complications in single-level lumbar fusion: an analysis of 4588 surgical cases. Spine 39:510–520. https://doi.org/10.1097/BRS.0000000000000163

    Article  PubMed  Google Scholar 

Download references

Funding

No funds were received in support of this work. No benefits in any form have been or will be received from any commercial party related directly or indirectly to the subject of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kern Singh.

Ethics declarations

Conflict of interest

The authors declare that the article and its content were composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethical approval

IRB Approval: ORA #14051301.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (PPTX 277 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jenkins, N.W., Parrish, J.M., Mayo, B.C. et al. The identification of risk factors for increased postoperative pain following minimally invasive transforaminal lumbar interbody fusion. Eur Spine J 29, 1304–1310 (2020). https://doi.org/10.1007/s00586-020-06344-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-020-06344-4

Keywords

Navigation